1. If an otherwise healthy patient with normal body weight develops fatty liver disease, it would be especially important to evaluate their

a.

blood glucose level.

b.

alcohol intake.

c.

total fat intake.

d.

use of nonsteroidal anti-inflammatory drugs (NSAIDs).

ANS: B

Fatty liver disease can also be associated with diabetes, and so blood glucose level may also be somewhat relevant. A high fat intake may exacerbate but would not cause fatty liver disease. Use of NSAIDs does not cause fatty liver disease.

2. If an obese postmenopausal woman who does not drink alcohol develops fatty liver disease and wants to avoid progression to cirrhosis or liver cancer, the best recommendation is to

a.

decrease intake of saturated fats.

b.

decrease intake of carbohydrate.

c.

lose 3 to 4 lb per week.

d.

lose 1 to 2 lb per week.

ANS: D

For an obese woman, gradual weight loss, 1 to 2 lb per week, probably helps reverse fatty liver disease and prevents progression. More rapid weight loss may exacerbate fatty liver disease and would result in loss of muscle tissue, as well as body fat. Decreasing intake of fructose may be helpful, but a general decrease in carbohydrate intake is not necessarily recommended other than to reduce energy intake. A decrease in total fat intake may be helpful and may help decrease energy intake, but a specific decrease in saturated fat intake is not warranted for this condition.

3. If a client will be visiting an area where hepatitis E virus (HEV) is endemic, the best way to prevent becoming infected is to

a.

eat only cooked fruits and vegetables and drink only commercially bottled water.

b.

eat only at internationally recognized establishments.

c.

obtain a vaccination before entering that area.

d.

avoid and raw or unpasteurized dairy products.

ANS: A

HEV is transmitted via the fecal-oral route, so avoiding raw fruits, raw vegetables, and potentially contaminated water helps prevent infection. Even internationally recognized establishments may employ infected food workers. Dairy products are less common sources of HEV. A vaccination for HEV is not available.

5. In treating patients with hepatitis, it is important for nurses to help patients cope with the challenge of

a.

difficulty sleeping.

b.

risk of bleeding.

c.

sodium restriction.

d.

fluid restrictions.

ANS: C

For patients with hepatitis, poor appetite makes it difficult to maintain adequate nutritional intake. Fluids are generally encouraged rather than restricted, especially to replace losses from vomiting or diarrhea. Sodium intake does not need to be restricted. Patients are usually very tired and would rather sleep than eat.

6. An individual may be at risk for HEV infection if they travel to India and eat

a.

curried shrimp.

b.

fresh fruit salad.

c.

Tandoori chicken.

d.

cooked foods from street vendors.

ANS: B

HEV is transmitted via the fecal-oral route; food prepared by infected food handlers may transmit the disease. Raw fruits and vegetables (e.g., fruit salad) are common sources of infection. Foods that are cooked, such as curried shrimp and Tandoori chicken, and foods cooked by street vendors are not common sources.

7. For patients with hepatitis, an important way to minimize loss of muscle mass is to

a.

participate in daily aerobic exercise.

b.

participate in daily strength exercise.

c.

maintain an adequate protein intake.

d.

maintain an adequate micronutrient intake.

ANS: C

Adequate protein intake does not prevent loss of muscle mass but does help minimize it. Patients with hepatitis need to rest to promote recovery and healing; their bodies cannot handle the stress of exercise. Maintaining adequate intake of micronutrients is important but does not specifically help maintain muscle mass.

8. The person at greatest risk for developing cirrhosis or liver cancer is a(n)

a.

young woman who drinks a glass of wine every day.

b.

young man who travels extensively to tropical countries.

c.

middle-aged overweight man with gallstones.

d.

older adult infected with hepatitis C virus (HCV).

ANS: D

Infection with HCV often progresses to cirrhosis or liver cancer; the progression is more rapid in older adults. For a woman, drinking less than 2 drinks a day should not cause liver damage. Traveling to tropical countries does not necessarily increase risk for cirrhosis or liver cancer as long as appropriate precautions are taken to prevent hepatitis infection. Gallstones are not related to liver cancer or cirrhosis.

9. If a patient with cirrhosis of the liver has a soft diet order, he or she probably has

a.

lethargy.

b.

cholelithiasis.

c.

esophageal varices.

d.

hepatic encephalopathy.

ANS: C

A low-fiber, soft diet is recommended for patients with esophageal varices because fibrous or abrasive foods could cause potentially life-threatening bleeding. Patients with cholelithiasis should follow a low-fat diet; patients with hepatic encephalopathy should restrict their protein intake. Lethargy associated with liver disorders may make a soft diet easier to eat, but this would not be the reason for the diet order.

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10. A good meal for a patient with ascites would be

a.

canned minestrone soup with saltine crackers.

b.

baked chicken with a roll and steamed green beans.

c.

bacon, sausage, eggs, and toast.

d.

tortilla chips with nacho cheese and salsa.

ANS: B

Patients with ascites should restrict their intake of sodium to limit fluid retention. Baked chicken, a roll, and steamed vegetables have low levels of sodium. Canned soups, cured meats, processed cheese, and chips have high levels of sodium.

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11. If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing

a.

fatty liver disease.

b.

hepatitis D.

c.

secondary depression.

d.

hepatic encephalopathy.

ANS: D

If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing hepatic encephalopathy because the brain is influenced by compounds that have been absorbed from the intestine and have not been metabolized by the liver. Fatty liver disease develops first, before progression to cirrhosis. Any form of hepatitis can lead to cirrhosis, but cirrhosis does not cause hepatitis. Depression may cause apathy, but it does not usually cause confusion.

12. If a patient with cirrhosis of the liver is treated with lactulose and neomycin, he or she probably has

a.

a secondary infection.

b.

ascites.

c.

esophageal varices.

d.

hepatic encephalopathy.

ANS: D

Neomycin is an antibiotic used to sterilize the bowel to decrease the amount of urea that can be converted to ammonia, and lactulose is used to lower stool pH, which traps ammonia in the colon; these two drugs are used to decrease ammonia levels in hepatic encephalopathy. Esophageal varices are not treated with medications. Ascites is treated with sodium restriction. Secondary infections may be treated with neomycin but not with lactulose.

13. Someone who drinks one glass of wine every night with dinner plus an occasional beer when watching a football game would be considered to be

a.

alcoholic.

b.

an alcohol addict.

c.

a moderate drinker.

d.

a heavy drinker.

ANS: C

Someone who drinks one to two drinks per day is considered a moderate drinker. A heavy drinker consumes three or more drinks daily. Alcoholism (which is the condition of being an alcohol addict) is a disabling addictive dependence on alcohol, usually characterized by intake of significantly more than one to two drinks daily.

14. If a person has no history of liver disease but does have a strong family history of cardiovascular disease, the person may help decrease the overall risk for chronic disease by

a.

following a lacto-ovovegetarian diet.

b.

avoiding use of NSAIDs.

c.

abstaining from drinking any alcoholic beverages.

d.

drinking one or two servings of alcoholic beverages daily.

ANS: D

Moderate alcohol intake may help reduce risk of heart disease and is acceptable for people without any history of or risk factors for liver disease. Abstaining from drinking alcohol would not increase cardiovascular risk, but it also would not decrease risk. NSAIDs do not affect cardiovascular risk. Following a lacto-ovovegetarian diet may increase cardiovascular risk if it includes large quantities of eggs and high-fat dairy products such as cheese.

15. If a malnourished patient with cirrhosis of the liver seems to be vulnerable to development of hepatic encephalopathy, the best food to give them would be

a.

scrambled eggs.

b.

roast beef with gravy.

c.

a hamburger.

d.

a bean burrito.

ANS: D

Vegetable proteins produce less ammonia than do animal proteins, and so the bean burrito would be a good source of protein for a malnourished patient at risk for hepatic encephalopathy. Scrambled eggs, roast beef, and hamburgers all provide animal protein.

16. If a patient with end-stage liver disease gains 5 lb in 1 week, the most likely explanation is

a.

development of ascites.

b.

restoration of muscle mass.

c.

high energy intake.

d.

edema in the extremities.

ANS: A

In a patient with end-stage liver disease, sudden weight gain is usually a sign of ascites. Muscle mass would not be restored this quickly, even with plenty of exercise and good nutritional intake. Energy intake high enough to produce this much weight gain is unlikely because patients with liver disease often have poor appetite. Edema in the extremities is more common with congestive heart failure.

17. A patient with end-stage liver disease may lose fat stores and muscle mass, but this may not be evident from measurements of body weight because of

a.

dehydration.

b.

fat redistribution.

c.

ascites and edema.

d.

electrolyte imbalances.

ANS: C

Many patients with end-stage liver disease accumulate fluid, manifested as ascites and edema. This increases body weight, which may mask fat and muscle losses. Patients with end-stage liver disease are not usually dehydrated and do not usually have electrolyte imbalances. Fat infiltrates the liver but is not otherwise redistributed in the body.

18. After liver transplantation, long-term nutrition recommendations most closely resemble those for patients with

a.

hepatitis.

b.

gallstones.

c.

peptic ulcer disease.

d.

metabolic syndrome.

ANS: D

Long-term nutrition management after liver transplantation needs to be tailored to help prevent excessive weight gain, hypertension, and hyperlipidemia; recommendations would be most similar to those for patients with metabolic syndrome. Patients with hepatitis usually need to be encouraged to eat more; those with gallstones need to decrease total fat intake, and peptic ulcer disease is mostly managed with drug therapy and stress reduction.

19. An example of an individual who may be at high risk for gallstones is a(n)

a.

underweight woman who runs 3 miles four times a week.

b.

overweight man who smokes and has a sedentary job.

c.

overweight man who has recently begun an exercise program.

d.

mother with four children who has lost 25 pounds in the past 3 months.

ANS: D

Rapid weight loss increases risk for gallstones, and so a mother who has lost 25 pounds in the past 3 months could easily develop gallstones. Underweight, regular exercise, smoking, and eating eggs do not increase risk for gallstones. Overweight increases risk for gallstones, but less than rapid weight loss.

blockage of the bile duct by gallstones, bacterial infection, or ischemia.

b.

concentration of bile in the gallbladder that favors formation of gallstones.

c.

failure of the gallbladder to contract and release bile into the small intestine.

d.

intake of excessive amounts of cholesterol and fat, in combination with bacterial infection.

ANS: A

Cholecystitis occurs when gallstones block the cystic duct or as the result of stasis, bacterial infection, or ischemia of the gallbladder. Concentration of bile in the gallbladder causes cholelithiasis, or formation of gallstones. Failure of the gallbladder to contract and release bile may lead to gallstone formation; this may be caused by very low fat intake or dieting. Neither intake of excessive amounts of cholesterol and fat nor bacterial infection is associated with gallbladder disease.

21. The most beneficial dietary change for a patient with cholelithiasis and cholecystitis would be to

a.

avoid fried foods and creamy sauces.

b.

abstain from drinking alcohol.

c.

refrain from eating 4 hours before bedtime.

d.

avoid eggs, shrimp, and high-cholesterol foods.

ANS: A

A low-fat diet is used to treat painful symptoms associated with cholelithiasis and cholecystitis. Avoiding alcohol and following a low-cholesterol diet do not alleviate symptoms. Avoiding alcohol is indicated for diseases of the liver, not the gallbladder. Even though gallstones contain cholesterol derivatives, most cholesterol is made by the body and is not dietary. Refraining from eating 4 hours before bedtime would help prevent pain caused by heartburn but not that caused by gallstones.

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22. After surgical removal of the gallbladder (cholecystectomy), the nurse should counsel patients to

a.

follow a low-fat, low-cholesterol diet.

b.

ensure high intake of protein and fluid.

c.

eat a well-balanced diet as tolerated.

d.

avoid snacking between meals.

ANS: C

After cholecystectomy, long-term dietary restrictions are not needed. Some patients need to restrict fat intake for a few weeks during recovery, but not for the long term. High intake of protein and fluid is not needed. Including nutritious snacks may be helpful during recovery.

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23. If a nurse is beginning an enteral feedings for a patient with pancreatitis, the only appropriate type of formula is

a.

modular.

b.

hydrolyzed.

c.

intact.

d.

hypercaloric.

ANS: B

For patients with pancreatitis, formula must be hydrolyzed or elemental so that it does not require digestion and stimulate the pancreas. It is infused after most digestion takes place in the intestines and thus needs to be ready for absorption. Modular, intact, and hypercaloric formulas would stimulate the pancreas to produce digestive enzymes and this would cause great pain in a patient with pancreatitis.

24. At the beginning of an acute episode of pancreatitis, the nutrition priority is to provide

a.

a clear liquid diet.

b.

jejunal enteral feedings.

c.

parenteral nutrition.

d.

intravenous fluids.

ANS: D

At the beginning of an acute episode of pancreatitis, the main priority is to keep patients hydrated. Depending on the length of the episode, patients may need enteral jejunal feedings. Patients may be able to progress to a clear liquid diet, but this would not be the first step. Parenteral feedings are not generally used because of impaired immune responses and bowel atrophy.

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25. The only appropriate diet order for a patient with pancreatitis is to begin feedings via

a.

nasogastric tube.

b.

percutaneous endoscopic gastrostomy (PEG) tube.

c.

nasoduodenal tube.

d.

percutaneous endoscopic gastrojejunostomy.

ANS: D

Enteral feedings for patients with pancreatitis should be infused into the jejunum below the ligament of Treitz to decrease pancreatic stimulation. Infusion into the stomach or duodenum would stimulate the pancreas and greatly increase pain.

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26. For patients with any kind of liver disease, the most important dietary modification is

a.

abstaining from alcohol.

b.

decreasing fat intake.

c.

increasing protein intake.

d.

avoiding dietary fructose.

ANS: A

During treatment of any kind of liver disease, it is most important for patients to abstain from drinking alcoholic beverages. Increasing dietary protein may help with recovery, and decreasing fat intake may be generally beneficial as long as energy intake is adequate. Avoiding dietary fructose may be helpful to patients with fatty liver disease, but it is not the most important feature of therapy.

HCV is associated with sharing contaminated needles or tattooing or piercing equipment. Hepatitis D virus (HDV) is the type of hepatitis that only occurs as a co-infection with HBV. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are spread via contaminated food and water. HAV, HBV, and HDV are transmitted via sexual contact.

29. As a patient who has undergone liver transplantation heals, a necessary transition is

a.

increasing protein intake to replace pretransplantation losses.

b.

restricting fluid and sodium intakes to prevent ascites.

c.

generally eating less to avoid weight gain and chronic disease.

d.

generally eating more to maintain body weight and muscle mass.

ANS: C

Patients who have undergone liver transplantation require extra energy and protein during recovery, but in the long term they should generally eat less to avoid excessive weight gain, hypertension, hyperlipidemia, and diabetes. After healing is complete, their protein needs are similar to those of other healthy adults. Sodium intake should be moderate, but fluid restriction is unnecessary; ascites is unlikely to occur as long as the new liver is functioning well.